In this changing culture children who once were viewed as fat--and teased about it--are now considered ordinary, their self-esteem boosted by what have come to be called "fat role models" such as Queen Latifah, Rosie O'Donnell and John Goodman (not to mention any NFL offensive lineman). Acceptance only fuels the epidemic. Overweight children are more likely than their healthy peers to become obese adults, begetting further generations of overweight citizens. "Where do we wind up at the end of this road?" asks William Dietz, the CDC's director of nutrition and physical activity. "With a population that is medically handicapped and with a bankrupt health-care system. The cost is enormous."
The reasons for this crisis are numerous (box, below), but solutions are as handy as the nearest organization devoted to weight loss, healthy eating or exercise. What seemingly cannot be overcome is Americans' denial of their corpulence. (The CDC estimated in 2000 that 64.5% of U.S. adults were overweight and 30.9% were obese.) Two years ago the nonprofit Institute of Medicine, based in Washington, D.C., impaneled 19 specialists in a wide range of disciplines and asked them to come up with a plan to win the fight against obesity. On Sept. 30 the panel issued a report asking for what Robinson, a panelist, described as "nothing less than a revolution" in society, with sweeping changes in diet and exercise, and an emphasis on prevention, not treatment.
The cause of obesity is simple: "An imbalance of energy intake over energy expenditure," says Steven L. Gortmaker, professor of society, human development and health at the Harvard School of Public Health. "Eating versus activity." The last 30 years have seen explosive changes in both areas.
?EATING The fast-food industry, which was born in the 1950s, took off in the '70s and was supersized and invited into schools in the '80s and '90s. As a result Kristie Andres, a physical-education instructor in Fairhope, Ala., sees students arriving at her elementary school with paper sacks containing fast-food breakfasts. "They've already been to Hardee's, and they've got their sausage biscuit and a Coke," says Andres. "And by the afternoon they're talking about going to KFC after school." Four years ago Andres had a student who weighed 185 pounds at the start of third grade, and one day the boy was so short of breath during moderate exercise that she thought he was having a heart attack.
While VanHeest was organizing her program for Parker Memorial, she came across two 10-year-olds whose parents had already placed them on the Atkins Diet.
?ACTIVITY Over the last half century, technology--first television, then video games and finally the Internet--has lured children indoors. In two-income and single-parent homes, these electronic devices are virtual babysitters, and their overuse is, according to study after study, an accurate predictor of obesity in children. The CDC has recommended 60 minutes a day of exercise for school-age children. Many of them spend far more time in front of the TV or the computer.
Residents of suburbs rely on cars for nearly all their transportation, and parents stymie what little wanderlust their children might feel out of fear of abduction by unseen pedophiles. "There is a much greater chance that your child is going to be dangerously overweight from staying inside than that he is going to be abducted," says James Sallis, a professor of psychology at San Diego State and cocreator of a phys-ed program used in hundreds of schools across the nation. "Yet the fear of abduction looms large in people's imaginations."
"One of the worst things that happened was the milk-carton campaign," says Dietz, of the effort to locate missing children by posting their photos on the sides of cartons. "It made people feel that if their children were outside, they would be abducted--when, in fact, most abductions are family-related. It contributed to the notion that it's dangerous for children to be outside." That's one of the reasons, says Robert Putnam, professor of public policy at Harvard and author of Bowling Alone, a 2000 best seller that examined the increasing disconnectedness of Americans, that "our kids are growing up isolated in front of glowing screens."
These changes have driven children away from exercise, and we're left with a bunch of overweight kids. Specialists on obesity suspect that the epidemic will worsen before it improves. If it improves. "What do I think is going to happen?" asks Colorado's Hill. "I am afraid that [society] probably is not going to deal with this properly. Our kids will be obese and, by the age of 12, on five drugs to manage their diabetes and high blood pressure and high cholesterol. The most likely scenario is that anyone who is not genetically protected will become obese, and we will just accept that we're an obese society. It depresses me to think about it in those terms."
Americans love sports, but mostly from their seats. "We're not a nation that plays sports," says Hill. "We're a nation that watches." Sports have too long been neglected as a means of promoting our children's health, but they can reestablish a beachhead in kids' lives on three levels--if inherent problems in each area can be overcome.